Secular Exemptions: Between Religious Freedom and Patient Choice

There have been extensive debates in the US about “religious exemptions” in health care. Through such exemptions, religious health providers are not required to provide services that, though legally obligatory, would violate their religious conscience. Such exemptions are considered necessary to protect the freedom of religious health providers. But they also place religious freedom in conflict with the freedom of patients to choose their preferred medical treatments. This framing of “religious exemptions” thus presumes that religious health care providers are more limiting to the freedom of patients than their secular counterparts.

In this paper, I contest the seeming conflict between religious freedom and patient choice at the heart of arguments against, and in favor of, religious exemptions. Such arguments fail to balance the services that religious providers do not provide, because of their religious mission, with those that they do provide because of it. This obscures the possibility that, whatever services they are exempt from, religious providers may on the whole give patients more choice than their secular counterparts. Thus, religious providers can, because of their very religiosity, enhance the freedom of choice of their patients.

They can also facilitate the functioning of the very secular health providers to which they are putatively “opposed.” Religious providers frequently provide services that are not available in secular facilities, and do so for populations that may not otherwise be able to receive care. Because of their enhanced range of services, they can allow secular institutions to be “exempt” from providing treatments that patients need. Such “secular exemptions” form an essential context for evaluating existing arguments regarding exemptions taken by religious providers of care.

I make this argument through a comparative ethnographic study of two distinct end-of-life providers in Atlanta, Georgia: a secular hospice provider that I will refer to as “Amberview Hospice,” and a Catholic, charitable end-of-life care facility called Our Lady of Perpetual Help Home. I argue that “Our Lady,” because of its religious foundation, provides a range of services that are not available at Amberview, even as they are desperately needed by some dying patients and families. In this sense, it is ultimately a “freer” facility than Amberview, and would likely remain so even if it were prohibited, for religious reasons, from providing certain services, such as physician-assisted suicide. It also makes it possible for Amberview to responsibly discharge patients that, because of its own limitations, it is unable to treat.

My goal is not to argue that religious institutions are superior to their secular counterparts. Rather, I hope to counter the assumption, underlying our discussion of “religious exemptions,” that secular institutions are themselves superior. Through such an argument, I hope to demonstrate how secular and religious providers can and do work together to improve patient care, and how they might ally politically to further the significant interests that they share.